We analyzed the surgical result of pars plana vitrectomy using silicone oil tamponade and evaluated the effect of different silicone oil viscosity on the result. Of all 66 patients, 48 were male and their mean age was 45.9 years. The most common underlying disease was proliferative vitreoretinopathy (29 patients) and 54 patients (81.9%) had visual acuity of 5/200 or less. Mean follow-up period was 8.94 months. Twenty eight patients had undertaken two or more vitreoretianl surgeries. Anatomical and functional success was achieved in 57 (86.4%) and 31 patients (47.0%), respectively. Complications included hypotony (7 patients), increased intraocular pressure (6 patients), keratopathy (4 patients) and closure of inferior iridectomy (3 patients) on the last follow-up. There was statistically significant correlation between preoperative and final visual acuity (p=0.0001), anatomical success and improvement of visual acuity (p=0.0057), and frequency of vitreoretinal surgery and final visual acuity (p=0.0143). There was no statistically significant difference in the surgical result between eyes using 1,000 cSt and 5,000 cSt silicone oil. This result suggests silicone oil injection may effectively support the surgical treatment of intractible retinal detachment. However, difference of its viscosity seems to make little effect on the surgical result.
Follow-Up Studies ; Humans ; Intraocular Pressure ; Iridectomy ; Male ; Retinal Detachment ; Silicone Oils* ; Viscosity* ; Visual Acuity ; Vitrectomy* ; Vitreoretinal Surgery ; Vitreoretinopathy, Proliferative

Toxic epidermal necrolysis (T~EN) is a severe mucocutaneous disease characterized by epidermal necrosis possibly extended to the entire body surface and involving multiple internal organs. Digestive tract may be involved too, but there is few report about gastrointestinal lesion in patient with TEN. Recently we experienced a case of TEN with gastrointestinal bleeding in previously healthy 32-year-old woman. The condition developed three days after the initiation of treatment with NSAID and progressed caudally, involving 60 percent of the skin surfaces. During a period of admission gastrointestinal bleeding was noticed. The gastrofiberscopy showed diffuse superficial mucosal lesion with oozing from swollen friable and erythematous mucosa. The skin lesion was progressed inspite of withdrawal of causative agents. The patient was expired due to combined septic shock 10 days later. We report this case with gastrofiberscopic findings and a brief review of literature.
Adult ; Female ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Mucous Membrane ; Necrosis ; Shock, Septic ; Skin ; Stevens-Johnson Syndrome*

Previous studies showed that whole body vibration could prevent bone resorption and stimulate new bone formation. The aim of this study is to detect and track effect of whole body vibration for osteoporotic bone of OVX rats. 12 Female rats were used and allocated into 5 group, CON, SHAM, WBV 17, WBV 30 and WBV 45. Rats except SHAM group were ovariectomised to induce osteoporosis. Rats in WBV groups were stimulated whole body vibration at magnitude of 1 mm(peak-peak) and frequency 17 Hz, 30 Hz and 45 Hz, repectively, for 8 weeks (20 min, 5 days/week). The 4th lumbar in rats were scanned at a resolution of 35 micrometer at baseline, before stimulation, and 8 weeks by In-vivo Micro-CT. To detect and track changes of morphological characteristics in lumbar trabecuar bone of rats, structural parameters were measured and calculated from acquiring images. In the results, changes of structural characteristics of WBV group were smaller than those of CON group. Loss of quantity of trabecular bone in WBV 45 was the least. In contrast, that in WBV 17 was the biggest. These results showed that reasonable whole body vibration beneficially affected osteoporotic bones. In addition to, whole body vibration was likely to be substituted partly for drug treatment.
Animals ; Bone Resorption ; Female ; Humans ; Osteogenesis ; Osteoporosis ; Rats* ; Vibration*

BACKGROUND: Most morphometric studies of the airway have relied on plain radiographs or CT scan with their attendant limitations. We evaluated the length from vocal cord to carina and diameter of the trachea in adults who had no abnormality of the airway using three-dimensional chest CT scan and compared with demographic data. METHODS: We performed a multiplane reconstruction of the airway using axial, sagittal, and coronal slices (aged 18-87, 100 men, 100 women). We measured that the lengths from vocal cord to carina and the diameters (AP, anteroposterior; TR, transverse) of 50 mm above carina of the trachea. RESULTS: The lengths from vocal cord to carina was 130.2 +/- 11.4 mm in men and 119.5 +/- 10.5 mm in women. The AP and TR diameters of the trachea at 50 mm above carina were men; 18.0 +/- 2.4 mm, 17.2 +/- 2.6 mm, women; 14.4 +/- 2.0 mm, 14.4 +/- 1.9 mm, respectively. The correlation between airway length and age and height was statically significant in men and women but less clinically significant. The correlation between diameter of trachea and height was only statically significant in men but less clinically significant. CONCLUSIONS: This study suggests that these measured data are helpful for the endotracheal intubation and endotracheal tube placement in airway management.
Adult ; Airway Management ; Female ; Humans ; Intubation, Intratracheal ; Male ; Thorax ; Trachea ; Vocal Cords

Superior vents lava(SVC) syndrome is mostly related to a malignant process, but many different benign causes haute also been described. We report a case of SVC syndrome caused by Klebsiella pneumonia diagnosed by sputum culture and serial chest X-ray changes. A 27-year-old man had been in stable health until three days before admission, when he complained of pleuritic chest pain, facial flushing, and shortness of breath. Examination of the head and neck disclosed edema of face and both arms, and jugular venous distention to the angle of the jaw. The chest auscultation resealed decreased breath sound without crackle on right upper lung field. The chest roentgenogram showed homogenous air space consolidation on right upper lobe, asociated with downward displacement of minor fissure and contralateral displacement of trachea, but air bronchogram was not seen. We began antibiotic therapy under impression of pneumonia after assailable culture was taken from blood and sputum. SVC scintigraphy showed stasis of drain of right brachiocephalic vein at the proximal portion with reflux into the right internal jugular vein and faintly visible SVC via the collaterals. Sputum culture resealed Klebsiella pneumoniae. Antibiotic therapy resulted in a cure of infection and disappearance of facial swelling. Follow-up SVC scintigraphy after 20 days showed normal finding. We first report a case of SVC syndrome caused by klebsiella pneumonia
Adult ; Arm ; Auscultation ; Brachiocephalic Veins ; Chest Pain ; Dyspnea ; Edema ; Flushing ; Follow-Up Studies ; Head ; Humans ; Jaw ; Jugular Veins ; Klebsiella pneumoniae ; Klebsiella* ; Lung ; Neck ; Pneumonia* ; Radionuclide Imaging ; Respiratory Sounds ; Sputum ; Superior Vena Cava Syndrome* ; Thorax ; Trachea ; Vena Cava, Superior*

Spontaneous intracranial hypotension (SIH) occurs without any preceding events such as lumbar puncture, surgery, trauma, or medical illness. It is characterized by a postural headache that is aggravated whilst in the erect or sitting position, and is relieved in the supine position. A postural headache usually resolves either spontaneously or with conservative treatment. An epidural block is a very important treatment for lumbago and is mostly performed for pain control. However, an incidental dural puncture is possible during epidural block and anesthesiology and pain medicine doctor should be familiar with an epidural block. Radioisotope cisternography is a highly sensitive, reliable and safe technique for confirming of the presence and location of cerebrospinal fluid (CSF) leakage. We report two cases of spontaneous intracranial hypotension that was diagnosed by SIH through cisternography in a situation where the post-dural puncture headache was primarily suspected as being the cause. If a postural headache occurs after an epidural block through an epidural needle without CSF leakage, other causes e.g. dural puncture need to be identified.
Anesthesiology ; Cerebrospinal Fluid ; Headache ; Intracranial Hypotension* ; Low Back Pain ; Needles ; Post-Dural Puncture Headache* ; Punctures ; Spinal Puncture ; Supine Position

Localized scleroderma is a form of connective tissue disease in which the normally soft-textured surface of the skin hardens due to deposition of collagen within the dermis. Recently, UVA1 phototherapy with shorter wavelength in the UVA2 region has been shown to have excellent effect in the treatment of scleroderma, including systemic sclerosis. Here, we report a case of a 57 year-old female with linear scleroderma and manifestation of Raynaud's phenomenon who showed marked improvement after 13 sessions of whole body therapy with low dose UVA1. Ultrasound scanning and skin elasticity measurement were taken to evaluate therapeutic effectiveness of UVA1 phototherapy.
Collagen ; Connective Tissue Diseases ; Dermis ; Elasticity ; Female ; Humans ; Middle Aged ; Phototherapy* ; Scleroderma, Localized* ; Scleroderma, Systemic ; Skin ; Ultrasonography

BACKGROUND: A rapid increase in the desflurane concentration induces tachycardia and hypertension and increases the plasma catecholamine concentration. This study compared the desflurane-induced hemodynamic responses in hypertensive patients with those of normotensive patients. METHODS: Sixty patients, 30 normotensive patient (group 1) and 30 hypertensive patients (group 2), were scheduled to undergo elective surgery under general anesthesia. The hypertensive patients have been taking regular antihypertensive drugs and their blood pressure and heart rate was well controlled. Thirty normotensive patients were not premedicated. The inspired concentration of desflurane through the mask was increased abruptly to 12.0 vol%. The target was to produce an end-tidal concentration of desflurane (ETdesf) of 10.0 vol% which was maintained until the end of the study by adjusting the vaporizer dial setting. The heart rate (HR), blood pressure (BP), cardiac index (CI), systemic vascular resistance (SVR), ETdesf, end-tidal concentration of carbon dioxide, and peripheral oxygen saturation were measured at the baseline and every 30 seconds for 5 minutes after inhaling of desflurane and for 2 minutes after intubation. RESULTS: The HR, BP, and CI increased significantly in the two groups compared with the baseline. However, the HR, blood pressure, CI, SVR, and ETdesf were similar in both groups. In addition, there were no significant differences of hemodynamic changes between the beta-blocker and the calcium channel blocker in the hypertensive patients. CONCLUSIONS: In patients with well-controlled hypertension, the hemodynamic responses to desflurane are similar to those in normotensive patients.
Anesthesia, General ; Antihypertensive Agents ; Blood Pressure ; Calcium Channels ; Carbon Dioxide ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension* ; Inhalation ; Intubation ; Masks ; Nebulizers and Vaporizers ; Oxygen ; Plasma ; Tachycardia ; Vascular Resistance

No abstract available.

A 57-year-old female with lumbar spinal stenosis at L4-S1 was scheduled to undergo posterolateral interbody fusion. Intubation with a 7.0 size ID cuffed reinforced tracheal tube (Mallinckrodt(TM), Mallinckrodt Medical Atholen, Ireland) was uncomplicated, and any air leakage was not detected at that time. Two hours after the start of operation, an air leak was apparent at the trachea during ventilation in the prone position. Closer inspection of the inflation tube and pilot balloon showed that the pilot balloon had become detached. Because she was being operated on in the prone position, and ventilation was only possible at a less than optimal state, we attempted to fix this without having to reintubate the patient's trachea. Our solution involved inserting a 21-gauge needle into the inflation tube and a handheld aneroid manometer was then connected to it. The tube cuff was thereafter inflated up to a pressure of 20 cmH2O. In conclusion, careful manipulation is recommended when performing intubation and a needle connector may help secure the airway if the pilot balloon becomes detached during the procedure.
Female ; Humans ; Inflation, Economic ; Intubation ; Middle Aged ; Needles ; Prone Position ; Spinal Stenosis ; Trachea ; Ventilation